Blog: Yasir Chowdhury, trainee neurosurgeon

Thursday 13 April 2017

Trainee neurosurgeon at University Hospital Coventry and Warwickshire, Yasir Chowdhury, shines a light on day-to-day life in one of the most complex and dangerous areas of surgery and shares his hopes for finding a cure for brain tumours

With his first-hand knowledge and driven by the need for more research into non-surgical treatments for brain tumours, Yasir is running the Virgin Money London Marathon for us on the 23 April

I was never the same after the sight of a living pulsating brain as a medical student. It was eerily beautiful.

My family had a huge influence on my choice of career. My father, in typical sub-continent fashion, decided I was going to be a doctor before I was conceived. My love for Meccano meant by the age of six I decided I was going to be a surgeon. It took another 17 years to decide I wanted to be a neurosurgeon.

Growing up a lot of my family members were affected by heart disease so I was naturally attracted to cardiac surgery but the brain always fascinated me. It was the enigma organ during medical school and I thought you literally had be a genius to operate on it. By chance I ended up in neuro-theatres one day and I was instantly spellbound watching a brain tumour being removed.

I knew from then on that this is what I wanted to do.

The first few years of training are all about learning the ropes on the wards managing patients for emergency and elective surgery. It's difficult in this period to look after the ward and begin to learn operating. Time spent operating therefore generally occurs by hanging around in the hospital after my scheduled day is finished waiting for emergencies.

I've recently made the transition from SHO to Registrar. Essentially this means more focus on operative training and holding the on-call registrar bleep. When on-call not only do you look after the wards but you now also look after all the neurosurgical emergencies in the region. Surrounding hospitals will be referring patients with bleeds in the brains, newly found tumours or paralysing spinal disc prolapses.

At the same time in A&E patients will be coming in with head injuries that need life-saving surgery. The responsibility is huge and terrifying at times. Being able to juggle multiple patients and decide on safe plans with the Consultant is essential in being a good registrar.

Many will say the actual surgery, as difficult as it may seem, is the easier part. Decision-making is what makes the job difficult.

Doctors by nature want to help people and I'm no different. Unfortunately, complications in neurosurgery can be crushing for everyone involved. Even in my very fledgling career there are patients I've looked after who will stay with me forever. One particular person always comes to my mind.

This gentleman was his late 70s; I'll give him the assumed name of David. He was a very independent chap and lived a very active life. He was telling me about his round of golf the day before. I was amazed by his relaxed attitude with everything - he certainly was not denial and was extremely insightful of what was happening. We went through the consent of the procedure and he was well aware of the risks

After having a seizure for the first time ever he was discovered to have a large tumour in a deep eloquent area of his brain. Any attempt to remove the tumour was deemed too high risk and so the decision was for a biopsy with a view to treat with chemo and radiotherapy.

David came into hospital with his wife on the day of his surgery in very good spirits. We went through the consent of the procedure and he was well aware of the risks.

The surgery went ahead, my consultant and I used an image-guidance system ('SatNav of the brain') to locate the tumour and after making a small hole in the skull I took a sample of the tumour using a biopsy probe. The sample was rushed off the lab for preliminary analysis whilst we waited in the operating room with David still under anaesthetic. The call came through after about 45 minutes and the conclusion was as suspected that it was a highly aggressive tumour.

Unfortunately, David also sustained a massive bleed around the tumour. A decision needed to be made whether a life-saving operation should be performed.

My consultant felt given he had highly aggressive tumour and now this massive bleed, the chances of him recovering even with further surgery were extremely low.

David wishes prior to the surgery were also in our mind and whilst my consultant finished the second case I went upstairs to speak to David's wife. As I walked into the room she smiled and asked how he was. This was the first time I was breaking bad news about I patient I had operated on myself.

I explained to her what had happened and that we felt the best thing for David would be not to intervene with a second operation and to let him pass away comfortably.

The conversation was extremely difficult and I literally had to hold back the tears. As distraught as she was she agreed David would want this too and so we brought him up to the ward.

My drive home that evening was difficult. I played the entire operation from start to finish trying to find where I had gone wrong. I knew biopsies of tumours can always bleed and my consultant was overseeing the entire procedure whilst I performed it. But even then I still felt guilty.

David's calmness will always remind that as brave as neurosurgeons are, the patients are always braver.

Working in neurosurgery is literally a roller-coaster ride and despite the difficulties I love my job. It is humbling and exciting at the same time. It may seem strange to some but I still stand in awe at the sight of a brain in the operating room just as I did as a medical student.

I only hope one day as a Consultant, I'll be making the right decisions by my patients.

Hopefully one-day people like David won't need to undergo such high-risk operations. Research allows for the development of non-invasive techniques to battle this horrible disease. Much like other cancers, the ideal treatment would come in the form of a tablet.

The life expectancy of our patients will ultimately increase by scientific research and faster diagnoses.

This is why I'm running the London Marathon for The Brain Tumour Charity.